PEPID's July Newsletter
In This Issue
Risks Of Adrenal Insufficiency
Glucocorticoid-Induced Adrenal Insufficiency (GIAI) is a condition caused by the prolonged use of glucocorticoids, which suppresses the hypothalamic-pituitary-adrenal (HPA) axis, leading to adrenal insufficiency. This condition is seen in approximately 1% of individuals on chronic glucocorticoid therapy, commonly prescribed for their anti-inflammatory and immunosuppressive properties. The suppression of the HPA axis occurs through the inhibition of corticotropin-releasing hormone (CRH) by the hypothalamus and adrenocorticotropic hormone (ACTH) by the pituitary gland, mirroring the body's natural cortisol feedback mechanism. Prolonged glucocorticoid use can decrease the responsiveness of the anterior pituitary gland, increasing the risk of adrenal insufficiency. Symptoms of GIAI range from general malaise and fatigue to severe adrenal crisis, presenting as hypotension, altered mental status, weight loss, and hypoglycemia. Diagnosis involves a detailed medical history, physical examination, and laboratory tests including serum cortisol and ACTH levels. Treatment focuses on gradually tapering glucocorticoid therapy to allow recovery of the HPA axis, with specific tapering regimens based on dosage and duration. In cases of adrenal crisis, immediate management with intravenous fluids and electrolyte balance is critical. Preventing severe withdrawal symptoms requires a slow reduction in glucocorticoid dose. For comprehensive information on Glucocorticoid-Induced Adrenal Insufficiency, consult PEPID's dedicated GIAI monograph.
Bone Complications from Radiation Therapy
Osteoradionecrosis, a severe condition involving bone death due to radiation, typically occurs after treatment for head and neck cancers. This condition primarily affects the jaw but can also impact other bones such as the cervical vertebrae. Osteoradionecrosis results from the poor vascularity of bone and soft tissues following radiation exposure, leading to avascular necrosis. Patients may develop exposed bone in the mouth, resulting in tooth loss and chronic infections that can progress to osteomyelitis and orocutaneous fistulae. Risk factors include receiving radiation doses greater than 6000 cGy, with symptoms potentially appearing years after treatment. Diagnosis involves a thorough oral and dental examination, imaging studies, and lab tests. Treatment typically includes hyperbaric oxygen therapy and surgical debridement of necrotic bone. Advanced cases may benefit from additional therapies such as pentoxifylline and tocopherol. Complications include chronic infections and pathologic fractures, which can escalate to systemic infections if not managed appropriately. For comprehensive information on osteoradionecrosis, consult PEPID's dedicated Osteoradionecrosis monograph.
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The Art of Compassionate Care in Nursing
Discover the heart of nursing with our latest blog post on 'The Art of Compassionate Care in Nursing.' Dive into the profound impact of empathy and compassion on patient outcomes and satisfaction. From the historical roots of nursing to practical tips for enhancing compassionate care skills, explore how these qualities are transforming healthcare delivery. Join us as we celebrate the art of healing with empathy, ensuring every patient feels valued and cared for. Get inspired on our blog, PEPID Pulse.